MIRockstarRN

the OB doc said that he was trying to avoid taking up a unit bed, told me that the ED said we could give pt appropriate care. we have 1:5 ratio at nights

the pt had been d/c from having the baby and was back home. apperentily you can have ecplamsia after you have given birth, not just while prgnant, which was the case with this pt...why she was on Mg+ gtt. OB doc said you cannot be admitted back once you have given birth... so this is the dilemea. our hospital doesn't have high risk OB unit.

Sunday night i was the contact nurse - nursing sup. calls with pt assignment of pt coming from ED that's 18yo 1 month postpartum, new onset seizures, HTN. Please keep in mind that I work on a tele surgical stepdown... openhearts, thors, general surgeries, bariatric surgery, and many cardiac gtts. When we got the fax report from ED it said pt was 1 week postpartum. I called nursing supervisor to ask if it was appropriate for pt to be on our floor as it sounded like more of an OB type issue not a tele issue. She called ED and said pt was fine to come to us, as "All seizure pt's are pt on tele". I told her we didn't know anything checking those OB things they check, she said all you have to do is check BP and call code if pt seizes again (pt was seizing and posturing when EMT's arrived at her house). So pt arrives, me and another nurse are looking over the pt's orders to help out our third nurse and see pt is on Mg+ gtt, and apparintly this new pt needs basically a whole assessment every hour according to orders. We called over to OB to ask them to come over and check the gtt as that is NOT something we do. OB doc came over also. When OB doc arrived, I told him that if this pt needed to be assessed hourily then she wasn't appropriate for our floor. OB doc tells me that if pt was on L&D and on MG+ she would have 1:1 nursing care!!!! :confused:I told him that we don't even do q2 hour blood sugars nor do we have staffing so pt needed to go somewhere else or we could get on OB nurse to care for pt and we could watch her tele. He said pt didn't even need to be on tele! OB doc called birthing center to see what could be done, then nursing sup calls and tells me she is working on moving pt. OB doc says pt can't go back to L&D because she had already delivered and was no longer pregnant, so the problem was trying to find an appropriate bed for her. Nursing sup calls with bed on peds with OB nurse to care for her then tells me that I was out of my scope by trying to get pt moved! I told her that all i did was ask a question of the Doc and found out pt was 1:1 care, she knew it wasn't appropriate for us! Needless to say, all admits after the spat with supervisor were CRAP (not the first time we have had issues with her). My question for you guys is this: where would this type of pt have ended up in your hospital???

the pt looks up and to the left

i work nights and we currentily have a day shifter working nights for $10 an hour extra. He has been on nights since this summer. When i first started ~2 years ago there were also several people getting the $10 hr extra - but at our hospital you must agree to 6 weeks. More than 3/4 of our staff has been on our unit for less than 1 year so having experinced day shift there to help out the new staff and orient is great. I don't think anyone is upset about them getting paid extra to do the same job as us, they are there to help out.

Feet....Yuck! The absolute worst is TED hose. The flaky skin that comes floating through the air when you pull them off is awful, i hold my breath because i'm afraid i'm going to inhale it! And putting them on you have to contend with there thick yellow nails, i'm always afraid i 'm going to get cut on the pts nails. I don't touch feet without gloves, ever!

If you have a pt who's cardiac enzymes come back elevated/positive, does your lab call the floor to inform that pt's RN? Where I work, any critical lab values are called to the floor and lab documents who they spoke to about the results. I have always wondered why cardiac enzymes don't get called - so had our charge nurse ask. This is the response from our lab "We only call critical values. Our policy on critical values is approved annually by the medical staff and there has been no interest to date to include cardiac enzymes. Our current policy does not include cardiac enzymes, which is similar to the policies at most labs. Our lab computer system is set up to print abnormal results on the floors which has been our way to communicate these results." So since they say it is the policy at most other labs, just wondered what you all have to say about that...Thanks!

interesting... where i work we require 2 RN's to pull sheaths. Seems scary to me to let unlicensed personal pull lines:uhoh3:

i understand what your all saying about the doc talking to the pt first then getting informed consent - but what happens at the hospital i work at is the docs will go in and talk to a pt, then write and order for the nurse to get consent. I work nights - if dayshift doesn't get the form signed, i have no idea if the docs actually talked to the pt about the procedure/surgery. i can ask if all there questions where answered, but that doesn't mean the doc actually answered any questions. I'm very uncomfortable about this whole thing - i have worked here for 2 years - and have come to think this was normal, even though in school they teach you is the surgeons/anesthesias responsibility. But since my coworker got written up (and i know what she did was wrong - but did it really require a write up, how but talking to that person like someone previosily posted) I really feel like the docs need to get there own consent signed.

This last weekend a co-worker (a nurse not even off orientation for maybe 2 months) mentioned that she had been written up by a PACU nurse for writing CABG instead of coronary artery bypass graft on the consent. I was telling my mom about this who is also an RN and she brought up a good point - why isn't the physician getting the consent signed. What do they do where you work? We are ALWAYS the ones that get consent where i work, often times without the physician or anesthesia talking with the patients first. I always ask my pt's if they would like to wait till they are talked to by the doc but then I feel like i run the risk of getting written up for not getting consent. What do you think???

have scrubs in longer lengths... 34-36 inseam.